FM CASE FILES 2 Flashcards
tx for GBS during pregnancy
penicillin
others: ampicillin, cephalothin, erythromycin, clinda
how to confirm rupture of membranes
see amniotic fluid leaking from cervix
polling of amniotic fluid in vaginal fornix
Nitrazine paper - pH >6.5 in vaginal fluid
ferning on dried slide
prolonged rupture of membranes predisposes to what
infection
define first stage of labor
contractions until complete cervical dilation
latent phase
active phase - starts at 4cm
rate of dilatation
epidural vs nonepidural
NO EPIDURAL
- 2cm / hr (nulliparous)
- 5cm / hr (parous)
define second stage of labor
delivery of fetus
normal duration of 2nd stage of labor
2 hours (nulliparous) 1 hour (parous)
epidural can prolong these times by 1 hour
normal duration of 3rd stage of labor
30 min
labor depends on 3Ps
power (strength of contractions)
passenger (size, lie, position)
pelvis (shape and size)
what can cause of false-positive nitrazine test
semen
blood
bacterial vaginosis
all can elevate pH
how do you assess fetal well being when mother is admitted to L&D
fetal heart rate monitoring
with a doppler ultrasound
or fetal scalp electrode
(requires membranes to be ruptured)
what 3 things do you look at in fetal heart rate tracings
baseline heart rate
variability
heart rate changes
normal baseline heart rate of fetus
110-160
normal variability of fetus
3-5 cycles per minute
comomn causes of decreased fetal heart rate variability
fetus sleeping
cns depressants (narcotic analgesics)
prematurity
fetal acidemia 2nd to hypoxemia
define fetal heart rate accel
15 beats/min
15 sec
what causes early decels
compression of fetal head
what causes late decel
uteroplacental insufficiency
causes:
maternal hypotension (given epidural or oxytocin)
maternal HTN, DM, placental abruptio
what causes variable decel
umbilical cord compression during contractions
what do you use to monitor uterine contractions and its strength
external toco
strength: IUPC (need ruptured membranres)
giving too much oxytocin during labor can result in what consequence
uterine hyperstimulation
late decels
cardinal movements during labor
refers to movement of fetal head
flexion
internal rotation (occiput to move anteriorly - symphysis)
extension
external rotation
maneuvers for shoulder dystocia
McRoberts Maneuver (hyperflexion)
suprapublic pressure
episiotomy
most calcium is found where in the body?
bones - 98% of total
bound to albumin - 1%
watch out for low albumin, causing low calcium (correct for this)
free - 1% (active)
formula for corrected serum calcium
corrected calcium =
[normal albumin - serum albumin] X 0.8(serum calcium)
what hormone decreases serum calcium and how?
calcitonin
causes increased renal excretion
what hormone increases serum calcium and how?
PTH
increases bone resorption by activating osteoclast
promotes kidney resorption
promotes GI absorption through calcitriol
most common cause of hypercalcemia
hyperparathyroidism
signs and sx
hypercalcemia
kidney stones
bone pain (arthritis, etc)
psychic (poor concentration, weakness, fatigue)
abdominal (pain, constipation, NV, pancreatitis)
first thing you look at when a pt has hypercalcemia
look at meds they’re taking
stop the suspected med
if a pt has hypercalcemia, what is the next step
order PTH
if PTH is low, feedback loop is working fine
if PTH is high or normal, feedback is not fine
(primary hyperparathyroidism)
how do you distinguish between primary hyperparathyroidism vs familial hypocalciuric hypercalcemia (FHH)
FHH is a genetic disorder
measure 24-hour urinary calcium
FHH: low calcium level
hyperparathyroidism: normal or elevated urinary calcium
if hypercalcemia, if PTH is low and Ca2+ is high, what lab test do you order next?
PTH-rP
parathyroid hormone related peptide
this is produced by cancers
lung, SCC of head and neck, kidney cx
how does PTH-rP work
osteoclast bone resorption
increases calcitriol (uptake in gut)
inc kidney resorption
tx for primary hyperparathyroidism
surgical removal of the adenoma
activities of daily living
bath dress eat toilet continence transfer from bed to chair
instrumental activities of daily living
transportation shop cook telephone manage money take meds housecleaning laundry
leading cause of blindness in elderly
age-related macular degeneration
what is macular degeneration
atrophy of cells in central macular region
leading to central vision loss
what is glaucoma
what is responsible for the disease
increased intraocular pressure
optic neuropathy
most common cause of blindness worldwide
cataracts
leading cause of blindness in working age adults in US
diabetic retinopathy
what is presbycusis
how does it present
age-related hearing loss
sensorineural hearing loss results in:
high-frequency loss
difficulty with speech discrimination
what is otosclerosis
autosomal dominant disorder of inner ear bones
loss of conduction
presents in 20-40s
speech discrimination is preserved
what is CAPD and contrast it with presbycusis
central auditory processing disorder
(CNS dysfxn)
has difficulty understanding spoken language
but hears sound well
quick cognitive screening test for dementia
clock draw
three-item recall
immunizations for ppl over 65
annual influenza
pneumococcal once
DPT booster
acute bronchitis
which antibiotic
none
antibiotics has not been shown to benefit
orgs in bacterial sinusitis (adults)
pneumococcus
h influenzae
orgs in bacterial sinusitis (children)
pneumococcus
h influenzae
moraxella catarrhalis
tx for acute sinusitis
first line
amoxicillin and bactrim
if fail, then 2nd line amoxicillin-clavulanic acid 2nd/3rd gen cephalo quinolones macrolides (azithro)
common causes of pharyngitis in teens/young adults
group A strep
mycoplasma pneumoniae
chlamydia pneumonia
arcanobacterium haemolyticus
group A strep findings
ABRUPT onset of sore throat/fever tonsillar/palatal petchiae tender cevical adenopathy NO COUGH sandpaperlike rash (scarlatiniform)
signs of
infectious mono
cervical and generalized adenopathy
HSM
atypical lymphocytes on smear
complication of infectious mono
splenic rupture to trauma
restrict sports
signs and sx
epiglottitis
cause?
stridor
drooling
toxic appearance
leaning forward (tripod position)
H influ
differential dx of tonsillar exudates
GAS EBV mycoplasma chlamydia adenoviruses
note: having tonsillar exudates does not automatically mean its bacteria vs virus
signs and sx
peritonsillar abscess
tonsil is pushed toward midline
uvula deviation
tx of peritonsillar abscess
surgical drainage
causes of peritonsillar abscess
strep
GAS
complications of GAS
rheumatic fever glomerulonephritis toxic shock syndrome peritonsillar abscess meningitis
does tx prevent poststreptococcal glomeruloneprhitis
NO
you can get it either way
tx for GAS
10-day course of oral penicillin
what is swimmer’s ear and what causes it
otitis externa
pseudomonas aeruginosa
common causes of otitis media
s pneumo
h influe
m catarrhalis
tx for otitis media
aomxicillin
alternative
amox/clavu
bactrim
2nd/3rd gen cephalosporins
immediate tx for chest pain
MONA
morphine
oxygen
nitro
aspirin
beta blocker
how does cocaine induce angina?
coronary artery spasm
patient is on clopidogrel needs bypass surgery, what do you do next?
withhold clopidogrel for 5-7 days before surgery
what is unstable angina
what is the immediate treatment
angina at rest
give platelet inhibitors gIIb/IIIa
how are beta blockers helpful in MIs
reduces infarct size
decreases mortality
reduces risk of another one
how are ace-i helpful in MIs
reduces shor-tterm mortality if started within 24 hours of MI
prevents LV remodeling
hypomagnesemia increases risk of what
torsades de pointes
what is benefit of CCB in MIs
which CCB is contraindicated in MIs
none
nifedipine - increases mortality
diet for MI patients
low saturated fat and cholesterol
risk factors for CAD
DM HLD age HTN smoking family hx of CAD Male postmenopausal LVH homocystinemia
why give statins right after having ACS
decreases incidence of major adverse cardiovascular events
what is goal LDL if using statins after MI
< 70
minimum duration of exercise
30 min
minimum weight reduction to get benefits
5% minimum
what is the Levine Sign
holding fist to chest
sign of MI
unequal upper extremity pulses is a sign of what
aortic dissection
tx for elevated potassium
kayexalate
insulin
retention enemas
causes of chronic renal failure
DM
HTN
glomerulonephritis
drugs that affect kidney fxn
nsaids
aminoglycosides
contrast
in chronic renal failure, what is the first step in management
remove anything that reduces renal perfusion: hypovolemia (give IV fluids) hypotension infection --> sepsis drugs that lower GFR like nsaids
goal of BP tx in chronic renal failure
< 130/80
what med do u treat BP with in chronic renal failure
ace-i
add diuretic if BP still not controlled
microscopic exam of trichomonas vaginalis
motile
flagellated
many wbcs
tx for trichomonas vaginalis
flagyl 2g one dose
and for partner as well
signs and sx
trichomonas vaginalis
green frothy discharge
strawberry cervix
vaginitis with recent abx use
what org is it
candida
vaginitis in a DM pt
what org is it
candida
describe candidal vaginitis
white discharge
no odor
VERY itchy
involves vulvar and vaginal areas (outside and inside)
tx for candidal vaginitis
single dose fluconazole
or
creams/vaginal suppositories
should you treat sexual partners of women with candidal vaginitis?
no, unless symptomatic
signs / sx
gardnerella vaginalis
pH > 4.5
positive KOH “whiff” test (fishy odor after adding KOH
clue cells on wet mount
tx for gardnerella vaginalis
metronidazole or clindamycin
oral or vaginal preparations
should sexual partners of gardnerella vaginosis be treated?
not necessary
as it does not reduce risk of recurrent infection
tx for gonorrhea
CTX
or Cipro
tx for chlamydia
doxycycline x 7 days
or azithromycin ONCE
and treat partners
what is PID
pelvic inflammatory disease
signs and sx
PID
inflammation of any of the reproductive organs ovaries fallopian tubes uterus cervix vagina
all you need for dx:
cervical motion tenderness
adnexal tenderness
tx for PID in prego woman or HIV
admit
parenteral abx
complications of PID
recurrence tuboovarian abscess chronic abdominal pain infertility ectopic pregnancy
diagnostic test for lower GIB
colonoscopy
what are hemorrhoids
dilated veins in the hemorrhoidal plexus of the anus
risk factors for hemorrhoids
chronic constipation
straining for BMs
pregnancy
prolonged sitting (truck drivers)
where do diverticula mostly occur
where blood vessels penetrate thru muscles of the colon
signs and sx
diverticulosis
painless bleeding
management of asymptomatic diverticulosis
dietary modification
high-fiber diet
management of hemorrhoids
high-fiver diet
stool softeners
contrast diverticulitis and diverticulosis
itis - painful inflammation
osis - not painful
usual location of diverticulitis
lower left quadrant
complication of diveritculitis
perforation resulting in:
peritonitis
intraabdominal abscess
tx for diverticulitis
bowel rest
abx (quinolone and metro)
if perforated –> surgery
major risk factor for IBD
family hx
IBD
besides GI, what are other common manifestations
arthritis
tx for IBD
symptomatic therapy
antidiarrheal
aminosalicylates
corticosteroids
precancerous polyps
name the 3
in order of increasing risk
tubular adenomas
tubulovillous adenomas
VILLOUS ADENOMAS
most common causes of CAP
pneumococcus
others
h influ
moraxella catarrhalis
common in very young and old
cause of pneumonia in COPD patients
h influ
atypical pneumonia
mycoplasma pneumonia
chlamydia pneumoniae
legionalla pneumphila
common in adolescent or young adults
risk factors for hospital acquired pna
intubation
NG tube
preexisting lung disease
multisystem failure
orgs in hospital acquired pna
aerobic GM-
pseudomonas
klebsiella
acinetobacter
GM+ cocci
staph aureus
ways to reduce intubation associated pna
use oropharyngeal vs naso
elevate head during feeds
infection control (wash hands, alcohol based disinfectants)
pneumonia with diarrhea
what bug
legionella
pneumonia after influenza
staph aureus
abrupt onset of pna
pneumococcus
sign of focal lung consolidation
egophony (E to A change)
sign of pleural effusion
dullness to percussion
cxr
ground glass infiltrates
pneumocystis carinii
AIDS patients
GI aspiration usually affects what lobe
right lower lobe
due to branching of bronchial tree
how to diagnose legionella
urine antigen testing
tx for pneumococcus pneumonia
beta lactam (ctx) or macrolide (azithromycin)
complications of pna
bacteremia
pleural effusion
tx for pleural effusion
if lots of fluid, do a thoracentesis with gram stain/cx
if empyema fluid, place chest tube for drainage
differential dx
depression
hypothyroidism
anemia
substance abuse
tx duration for depression
at least 6-9 months
if recurrent depression, treat for longer
side effects
SSRI
sexual dysfxn weight gain GI disturbance fatigue agitation
side effects
TCA
sedation dry mouth and eyes urinary retention wt gain sexual dysfxn HIGHLY TOXIC / FATAL IN OD
side effects
MAO-I
drug-drug interactions
SSRI and meperidine (Demerol)
side effect
buproprion
seizure
contraindicated in pts with seizure disorders
side effect
trazodone
priapism (persistent erection)
sedation (used for insomnia)
comorbidity of panic disorders
depression
bereavement vs depression
bereavement < 2 months
no suicidal ideations or psychosis
rule out what in depressed patients
bipolar
ask about mania
